Sine the new policy of 4 monthly prescriptions went into effect and I have 11, I've been having to battle with them over every little thing related to my health. Now mind you, Medicaid has no idea who I am besides a number and a name.
Every month when I need my 5th-11th prescriptions refilled my doctor(s) have to take time out of their busy days to call Medicaid and give the prior authorization in order for the pharmacy to refill my prescriptions.
My doctors are like every other doctor, BUSY! They don't have time to deal with this nonsense. I spoke to my new neurologist about this and she said it can take up to 2 hours for all of her patients that she does this for. That is time out of her day that she doesn't get paid for. Absolutely absurd!
The patient has to first fill out a form with all of the prescription information, script #, script name, doctors name, address, fax number, how many refills, my name address, phone # and then I have to fax it to the doctor. The doctor has to sign it then fax it to Medicaid. I have to do this 11 times! I quit! Literally, I quit doing it because it's BS!
I thought I got over that hurdle but then my prescriptions started getting denied. (Thankfully I held onto that email that I previously mentioned @ UIC). I emailed my Mediciad contact and inquired why my ONE and only Lupus pain medication was being denied and inquired whether it had anything to do with the 4 monthly limitation. I explained that I'm in incredible pain due to Lupus and other issues. The email was quite lengthy and I won't bore you with those details. I received and email back stating,
"Ms. Villalobos,
I apologize for the confusion. I have gone into the system and approved your
tramadol for a 1 year period. I have
notified the pharmacy and you are able to fill it at your convienence."
I'm not sure how someone, not knowing my health condition, can just deny my prescriptions. I went into Medicaids authorized medication list and was totally shocked my the narcotic list. It was longer than any other pharmaceutical on the chart! All I'm asking for is a medication that helps me get through the day so I am function and move.
The same month I received 7 more pharmaceutical denials. Yes, I emailed the same person inquiring why. I was very upset when I received a denial for my migraine medication considering I had been in the hospital once a month for 5 months straight and one month I was transported via ambulance. My idea is that Medicaid would want to help individuals get better and let them have the prescriptions provided to them by their physicians rather than denying them of their medications. Why would Medicaid want to pay hospital and ambulance fees rather than paying prescription fees? Seems cheaper to pay prescription fees. That's just my thought.
I wrote to my contact inquiring why I was denied for my migraine medication that my neurologist prescribed for me and I was angry at the response. I was told I could take a sumatriptan. I'M allergic to sumatriptan! Again! This person doesn't know me, my history, my file, etc....Not too mention a person that has Lupus is NOT supposed to take sumatriptan because it cause symptoms of a flare and Lupus "like" symptoms. If she knew my case, she would have known that, but since she didn't, well....we know the rest....
Since I keep a running log of all of my medications, what they're prescribed for, by which doctor, side affects, surgeries, doctors #'s, health conditions, medications I had been on prior, allergies; I emailed that to her.
I received an email in return tell me I'm approved for Botox injections for my migraines! Whoot-whoot! That's what my neurologist wanted!
On December 5, 2012, I went in and received 31 injections of Botox! The injections were on my forehead, temple, top of my head, back of head, nape of neck, and shoulders. I'm not going to lie. It did sting a bit. There wasn't any numbing involved. It took some time for the residual injection site pain to go away too. That hurt the worst! I think the shoulder and the nape of the neck were the worst. I was told that between 6-9 weeks is the point of where I should feel better. I've had about 3 OK days where I can actually say the migraines were tolerable; which is better than before.
I told my neurologist of the earlier emails and she was taken aback and asked how I got approved. I told her exactly what I did. Basically "WE" need to take a stand and stand for ourselves! If we don't do it, who will? Don't sit back and wait for someone to speak for you. It's your voice that needs to be herd, not your neighbors, but your voice!
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